A Message From "él Haney"

Welcome to ResusNation #138

The Cover-Up That Infected Hemophiliacs With HIV (And Why No One Went to Jail)

Forget the conspiracy theories—this real-life horror show happened in plain sight. In the 70s and 80s, thousands of hemophiliacs worldwide were handed a death sentence by the very “miracle cure” meant to save them: blood clotting factors (Factor VIII and IX). Here’s the dark secret: to pump out enough product, drug companies were pooling plasma from tens of thousands of donors, including paid, high-risk individuals like prisoners and addicts. When the AIDS epidemic hit, those mega-pools became lethal petri dishes, contaminating the medicine. Governments and Big Pharma knew blood could transmit the virus, yet they dragged their feet on implementing simple fixes like heat-treating the plasma. This wasn't a tragic accident; it was a deadly, unforgivable delay motivated by pure profit.

The true scandal isn't just that thousands were infected with HIV and Hepatitis C, it’s the decades-long institutional betrayal that followed. Regulators and corporations actively resisted mandatory screening and safer protocols, choosing to gamble with patients' lives rather than lose money. For years, they stonewalled, denied responsibility, and dismissed the mounting evidence of the carnage they had caused. While the victims died, official inquiries in multiple countries have since confirmed this profound and systemic failure. This is the ultimate case of medical malpractice: an entire vulnerable community poisoned by negligence, a cover-up that lasted for decades, and the sickening reality that, for many, the only thing that followed was an apology, not justice.

Welcome to the 138th Edition of ResusNation!

You're Using Too Much Dilt!

Anand Swaminathan has been doing this long enough to know the futility of trying to cardiovert chronic atrial fibrillation. You can ask Thor himself to come down and zap them with Mjölnir, and the patient will still be stuck in it. We all have that experience where we've cranked the energy up to 200 joules, maybe even tried dual-sequence defibrillation like some of my cardiology colleagues suggest, but at a certain point, you have to face the data: it's just not going to happen. Chasing rhythm control in a chronic A-fib patient in the acute setting often exposes them to unnecessary risk without real gain.

The real clinical imperative here shifts to safe and effective rate control. My rule of thumb is to first address the patient's underlying physiology, ensuring their volume status is optimized and maybe giving a prophylactic pressor before attempting to slow the rate. When it comes to agents like diltiazem, I significantly challenge the standard 0.25mg/Kg dose or even the 0.15mg/Kg dose. Anand typically starts at half the standard dose. Why? Because you can always give a second, smaller bolus, but you can't undo a steep drop in blood pressure caused by an overly aggressive initial dose.

Watch the full video here and leave a comment.

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Are You Feel The Burn?

Burnout among ICU staff is a global crisis. These clinicians work in some of the most demanding, emotional, and fast-paced environments in healthcare—conditions that make exhaustion almost inevitable. Burnout doesn’t just affect morale; it affects how providers think, communicate, and ultimately care for their patients. Recognizing the urgency of this issue, an international team conducted the “Hello” trial, one of the largest studies ever designed to improve workplace culture in the ICU. Their key finding? A simple, low-cost intervention cut burnout rates from more than 63% to just over 52% in participating units.

The “Hello” program ran for only four weeks, yet its tools were remarkably practical: positive posters, a box for sharing uplifting messages, brief team-building prompts, and leaders modeling supportive communication. Rather than placing more responsibility on already overwhelmed staff, the program reshaped the shared culture of the unit. The benefits went beyond burnout reduction—ICU teams reported higher job satisfaction, improved perceptions of safety, a better ethical climate, and stronger patient- and family-centered care. Although the intervention doesn’t solve deeper systemic problems like staffing shortages, the trial shows that small, intentional changes in how we interact can shift the emotional climate of an entire unit. Sometimes, the first step toward healing a strained system starts with a simple “hello.”

Here's my Takeaways:

• Finding: A simple, four-week intervention reduced ICU staff burnout by 11.1 percentage points, dropping from 63.3% to 52.2% in the intervention group.

• Practice Impact: Low-cost, unit-wide communication and support strategies can strengthen workplace culture, boost job satisfaction, and meaningfully reduce occupational burnout among ICU teams.

• Population: Results are highly generalizable, drawn from a diverse group of ICU clinicians—including nurses, physicians, and allied health professionals—across 370 ICUs in 60 countries.

• Limitation: The intervention’s effect was measured only over four weeks, so long-term durability remains unknown. It also did not address systemic contributors to burnout such as staffing shortages, workload intensity, and resource constraints.

Want to learn more? Read the full study "Noninvasive Ventilation for Preoxygenation during Emergency Intubation" by Gibbs KW, Semler MW, Driver BE, et al. in The New England Journal of Medicine (2024).

What’s up, ICU nerds? We're introducing a new section called "ICU Rounds" with ICU educator, Dr. Mahmoud Ibrahim.  So, grab a coffee and your thinking caps — let’s round with @ICUBoy.

When I say azelastine nasal spray, you’re probably thinking allergic rhinitis, right? But a brand-new JAMA study is asking whether azelastine could reduce COVID-19 infections. Wild, right? Let’s dive in.

The Why:

• COVID-19 devastated the world and our ICUs.

• Outside of vaccines, we have limited pre-exposure prophylaxis tools.

• Azelastine is a well-known antihistamine spray with anti-inflammatory effects — and intriguing in-vitro antiviral activity (SARS-CoV-2, RSV, influenza).

The What:

The CONTAIN Trial — randomized, placebo-controlled, single-center

The Who:

450 healthy volunteers in Germany. All SARS-CoV-2 negative, no acute illness.

• Average age: early 30s

• BMI: 24

• 98% vaccinated against COVID

What's The Intervention:

Azelastine 0.1% spray — 1 puff per nostril, 3×/day for 56 days

What's The Control:

Placebo spray for 56 days

The Question:

Can azelastine nasal spray reduce the incidence of COVID-19 infection?

Their Outcome:

PCR-confirmed SARS-CoV-2 infection

Let's Talk Results:

• Azelastine: 2.2% infection rate

• Placebo: 6.7% infection rate

• Odds Ratio: 0.31 (95% CI 0.11–0.87)

So...does this change my practice?

Not yet. Here’s why:

• Study population ≠ my ICU population (young, healthy, vaccinated).

• Limitations include modest sample size, single-center design, and exploratory nature.

But the idea that a cheap, well-tolerated spray could reduce infections? Super exciting. I’ll be watching for larger, multi-center trials or studies on therapeutic use in infected patients.

What do you think? Could this be a game-changer, or just noise? Reply below and let me know.

Weirdly yours,
ICUBOY
Click here to follow @icuboy_meded on IG & TikTok.

Watch the November's 
Videos Now!

If you're an All-Access Member, you're in for some great content this month. We have FIVE videos hand-picked by our staff that are high-yield and our most highly watched. We're featuring

• Mattu on "ECGs That You Cannot Miss"
• Strayer on "Make the Cut [A Cric Demo]"
• Schauer on "Trauma Contributions from the Military"
• Fornari on "Cerebral Edema in Pediatric DKA"
• Rezaie on "Danger Trial"

Each month we bring you fresh new content from the best of the best in resuscitation. If you're an All-Access member, go watch these videos NOW! If you're not, then sign up here.

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Do you want even more resus content anytime you want? For less than a cup of coffee, you can get even more content from @CriticalCareNow. Digital teaching sessions, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that @CriticalCareNow does live. 

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